PN 125 Exam 3 Study Guide Fall 2024 PDF

**[PN 125 Exam 3 -- Chap. 15, 16, 18, 20, 21, 22]** Barrier defenses & increasing risk of infection - **Barrier Defenses: Detailed Notes** - **Overview:** Barrier defenses are anatomical barriers that prevent the entry of foreign pathogens and protect the body as the first line of def...

**[PN 125 Exam 3 -- Chap. 15, 16, 18, 20, 21, 22]** Barrier defenses & increasing risk of infection - **Barrier Defenses: Detailed Notes** - **Overview:** Barrier defenses are anatomical barriers that prevent the entry of foreign pathogens and protect the body as the first line of defense. These barriers include: - **Skin** - **Mucous Membranes** - **Gastric Acid** - **Major Histocompatibility Complex (MHC)** - **Skin:** - The skin serves as the first physical barrier, protecting internal tissues and organs from external threats. - **Chemical Secretion:** Skin glands secrete chemicals that can destroy or repel pathogens. - **Shedding of Skin Cells:** The top layer of skin sheds daily, making it difficult for pathogens to colonize. - **Normal Flora:** The skin\'s normal bacterial flora also helps to destroy many disease-causing pathogens. - **Mucous Membranes:** - Mucous membranes line body areas exposed to external influences but lack skin protection, such as the **respiratory tract**, **gastrointestinal (GI) tract**, and **genitourinary (GU) tract**. - **Physical Barrier:** Mucous membranes provide a physical barrier to invasion and secrete sticky mucus that traps and inactivates invaders for later removal. - **Respiratory Tract:** - Lined with **cilia** (hairlike structures) that sweep captured pathogens or foreign materials toward the mouth, where they are swallowed. - **Coughing or Sneezing:** Cilia can also move the material to areas that trigger coughing or sneezing, aiding in its removal. - **Gastrointestinal Tract:** - The mucous membrane serves as a protective coating that prevents erosion of GI cells by the acidic stomach environment, digestive enzymes, and waste products. - It secretes mucus to lubricate the GI tract, facilitating the movement of food and waste. - Acts as a thick barrier, preventing pathogens from penetrating the GI tract. - **Genitourinary Tract:** - Provides direct protection against injury and trauma. - Traps pathogens for destruction by the body. - **Gastric Acid:** The stomach secretes **acid** in response to many stimuli. The acidity aids in **digestion** and destroys many ingested pathogens or those removed from the respiratory tract. - **Normal Flora:** Normal bacteria that thrive in this acidic environment also contribute to pathogen destruction. - **Major Histocompatibility Complex (MHC):** The body\'s **last barrier of defense** involves distinguishing self-cells from foreign cells. **Genetic Identification:** Each person has a unique genetic code, marked by the **major histocompatibility complex (MHC)**. - **Histocompatibility Antigens (HLAs):** Proteins produced by the MHC, located on cell membranes, help the body recognize its own cells. - Cells without these specific proteins are identified as **foreign** and targeted for destruction by the immune system. Adverse effects of salicylates **Adverse Effects of Salicylates: Detailed Notes** **1. General Adverse Effects:** - **Gastrointestinal (GI) Effects:** - Salicylates can directly affect the stomach lining, causing: - **Nausea** - **Dyspepsia** (indigestion) - **Heartburn** - **Epigastric Discomfort** - **Effects on Clotting:** - Salicylates interfere with clotting, which may result in: - **Blood Loss** - **Bleeding Abnormalities** **2. Salicylism:** - **Definition:** A condition that can occur with **high levels of aspirin** (chronic use or overdose). - **Symptoms:** - **Dizziness** - **Ringing in the ears (tinnitus)** - **Difficulty Hearing** - **Nausea and Vomiting** - **Diarrhea** - **Mental Confusion** - **Fever** - **Lassitude** (a state of physical or mental weariness) **3. Acute Salicylate Toxicity:** - **Toxic Doses:** - **Adults:** 20 to 25 grams - **Children:** 4 grams - **Signs of Toxicity:** - **Respiratory Effects:** - **Hyperpnea** (increased depth of breathing) - **Tachypnea** (rapid breathing) - **Pulmonary Edema** (fluid accumulation in the lungs) - **Neurological Effects:** - **Excitement and Confusion** - **Convulsions** and **Tetany** (involuntary muscle contractions) - **Coma** - **Cardiovascular Effects:** - **Hemorrhage** - **Cardiovascular Collapse** - **Other Systemic Effects:** - **Dehydration** - **Metabolic Acidosis** (buildup of acid in the body) - **Electrolyte Imbalances** - **Fever** - **Renal and Respiratory Collapse** **Summary:** - The adverse effects of salicylates range from common GI symptoms to life-threatening conditions in cases of overdose. Patients should be closely monitored for symptoms of **salicylism** and **acute toxicity**, particularly when using high doses or during long-term therapy. Nursing actions for an immunosuppressed patient 1. **Arrange for laboratory tests before and periodically during therapy (CBC, differential, liver, and renal function tests):** - **Rationale:** Monitoring these laboratory values is crucial to detect any potential adverse effects of the medication on the blood, liver, or kidneys and to ensure prompt intervention if needed. 2. **Administer the drug as indicated; instruct the patient and a friend, family member, or significant other if injections are required:** - **Rationale:** Proper drug administration is essential for effectiveness and safety. Teaching a caregiver ensures correct administration and provides additional support for the patient. 3. **Protect the patient from exposure to infections and maintain strict aseptic technique for invasive procedures:** - **Rationale:** Immunosuppressed patients are highly susceptible to infections due to compromised immune function. Aseptic techniques help minimize the risk of infection. 4. **Arrange for supportive care and comfort measures for flu-like symptoms (rest, environmental control, acetaminophen):** - **Rationale:** Immunosuppressive therapy can cause side effects such as flu-like symptoms. Providing supportive care helps alleviate these symptoms, improving patient comfort and adherence to therapy. 5. **Monitor nutritional status during therapy; provide small, frequent meals, mouth care, and nutritional consultation as necessary:** - **Rationale:** Immunosuppressive drugs can impact appetite and gastrointestinal function. Proper nutrition is crucial for overall health, immune function, and recovery. 6. **Instruct patients able to become pregnant in the use of barrier contraceptives to avoid pregnancy during therapy:** - **Rationale:** Immunosuppressive drugs may cause teratogenic effects or harm a developing fetus. Using barrier contraceptives is essential to avoid pregnancy during treatment. 7. **Suggest another method of feeding the baby if a patient is breastfeeding:** - **Rationale:** Many immunosuppressive drugs can pass into breast milk and may cause adverse effects in the infant. Alternative feeding methods should be used to protect the baby. 8. **Offer support and encouragement to help the patient deal with the diagnosis and the drug regimen:** - **Rationale:** Immunosuppressive therapy can be challenging for patients both physically and emotionally. Providing support and encouragement helps improve their ability to cope and adhere to the treatment plan. 9. **Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of problems, and proper administration:** - **Rationale:** Educating the patient empowers them to manage their therapy safely, recognize warning signs, and understand how to administer the medication properly, improving adherence and outcomes. These interventions address both the physical and emotional needs of immunosuppressed patients, focusing on minimizing risks, managing side effects, and ensuring safe and effective therapy. Therapeutic actions of tricyclic antidepressants **Summary of Therapeutic Actions and Indications of Tricyclic Antidepressants (TCAs)** **Tricyclic Antidepressants (TCAs)** work by **inhibiting the reuptake** of **serotonin (5HT)** and **norepinephrine (NE)**, leading to increased levels of these neurotransmitters and enhanced stimulation of the postsynaptic receptors. While the exact mechanism for treating **depression** is unknown, it is thought to involve this accumulation. **TCAs** are used primarily for **relief of depression** symptoms, especially when **anxiety** and **sleep disturbances** are present. They are also used for **enuresis** in children older than 6 years, and for conditions such as **chronic pain**, **neuropathy**, **fibromyalgia**, and **anxiety disorders**. **Clomipramine**, a TCA, is approved for treating **obsessive-compulsive disorders (OCD)**. **Detailed Notes** 1. **Mechanism of Action** - **TCAs** inhibit the **presynaptic reuptake** of the neurotransmitters **5HT (serotonin)** and **NE (norepinephrine)**. - This leads to an **accumulation of 5HT and NE** in the **synaptic cleft**, resulting in increased stimulation of the **postsynaptic receptors**. - The **exact mechanism** of action for decreasing **depression** is not fully known but is related to the increased levels of **NE and 5HT** in the **brain**. 2. **Indications for TCAs** - **Relief of Symptoms of Depression**: Especially effective in patients with **anxiety** and **sleep disturbances**. - **Sedative Effects**: The **sedative** nature of TCAs makes them more suitable for individuals who experience **sleep problems** along with **depression**. - **Enuresis in Children**: Some TCAs are effective for treating **enuresis** (bedwetting) in children older than **6 years**. - **Other Uses**: - Treatment of **chronic, intractable pain**. - Management of **neuropathy**. - Relief of symptoms related to **fibromyalgia**. - Treatment of **anxiety disorders**. - **Clomipramine**: Approved for treating **obsessive-compulsive disorders (OCD)**. 3. **Additional Effects** - **Anticholinergic Effects**: TCAs have **anticholinergic properties**, contributing to their **therapeutic effects** and side effects (e.g., **dry mouth**, **blurred vision**, **constipation**). **TCAs** are versatile medications that not only address **depression** but also provide therapeutic benefits for **pain**, **anxiety**, and specific conditions like **OCD**. Their **sedative** and **anticholinergic** properties make them especially suitable for certain patient profiles. Body's first line of defense The **skin** is the body\'s **first line of defense**, acting as a **physical barrier** to protect internal tissues and organs. Skin glands secrete chemicals that **repel or destroy pathogens**, and the **top layer** sheds daily, preventing colonization. Additionally, the **normal bacterial flora** on the skin helps eliminate harmful pathogens. Bipolar disorder & Lithium client teaching **Bipolar Disorder: Detailed Notes** **Characteristics:** - Bipolar disorder is characterized by extremes of mood, including periods of depression followed by periods of hyperactivity and excitement, known as mania. - There are four types of bipolar disorder, but all share this pattern of extreme mood swings. **Cause:** - The exact cause of bipolar disorder is not fully understood. - It may reflect a biochemical imbalance in the brain, leading to instability of certain neurons. - This imbalance results in an overcompensation mechanism, causing shifts between depression and mania. - There are also genetic links, indicating a hereditary component to the condition. **Mania:** - Mania is a state of hyperexcitability that occurs at the opposite end of the spectrum from depression. - In individuals with bipolar disorder, episodes of depression are followed by periods of mania. - The underlying cause of mania is thought to be an instability in the function of certain neurons in the brain. **Treatment:** - Traditionally, **lithium (Lithobid)** has been used to treat mania in bipolar disorder. - Today, treatment options also include several **atypical antipsychotics**, such as: - **Aripiprazole (Abilify)** - **Cariprazine (Vraylar)** - **Lurasidone (Latuda)** - **Olanzapine (Zyprexa, Zyprexa Zydis)** - **Quetiapine (Seroquel)** - **Risperidone (Risperdal)** - **Ziprasidone (Geodon)** - In addition, certain **antiepileptic agents** are also used to treat bipolar disorder (covered in more detail in Chapter 23). - **Evaluation of the Effectiveness of the Teaching Plan for Lithium** - **Patient Understanding:** - **Drug Name and Dosage:** - The patient can accurately name the drug (**lithium**) and state the correct dosage they are prescribed. - **Adverse Effects to Watch For:** - The patient can describe possible **CNS effects** such as lethargy, slurred speech, muscle weakness, and fine tremor. - The patient understands to watch for signs of **polyuria** and **gastric toxicity** (including nausea, vomiting, and diarrhea). - They are aware of the risk of **renal toxicity** and **cardiovascular (CV) collapse**. - **Measures to Avoid Adverse Effects:** - The patient understands the importance of maintaining **hydration** and **adequate salt intake** to help minimize the risk of toxicity. - They can explain the need for **periodic monitoring** of their serum lithium level to prevent adverse effects related to high or low lithium levels. - **Warning Signs to Report:** - The patient knows to immediately report any signs of **worsening CNS effects** (e.g., worsening tremor, severe muscle weakness), **significant changes in urination**, and **severe gastrointestinal symptoms**. - They understand the potential seriousness of symptoms like **severe vomiting or confusion** and the need to seek prompt medical attention. - **Need to Avoid Pregnancy:** - The patient understands the importance of avoiding pregnancy while taking lithium, due to its potential teratogenic effects. - **Effectiveness Indicators:** - The teaching plan is effective if the patient can clearly and accurately repeat the above information. - Periodic reassessment during follow-up visits ensures continued understanding and adherence to the guidelines. - These medications help stabilize mood and prevent episodes of both depression and mania. Treatment often requires a combination of medications and therapy to manage symptoms effectively. How does acetaminophen work to reduce a fever? Acetaminophen works to reduce a fever by acting on the thermoregulatory cells in the hypothalamus, the part of the brain that controls body temperature. It causes sweating and vasodilation (widening of blood vessels), which leads to the release of heat from the body, thereby lowering the fever. What nursing assessment do you need to prioritize for a client taking to much acetaminophen. **Liver Function**: Assess for signs of **liver damage**, as acetaminophen overdose can lead to liver toxicity. Look for symptoms like **jaundice** (yellowing of skin or eyes), **right upper abdominal pain**, and **dark urine**.  **Level of Consciousness**: Monitor the **level of consciousness**, as severe overdose can lead to **hepatic encephalopathy**, resulting in confusion, agitation, or decreased alertness.  **Gastrointestinal Symptoms**: Assess for **nausea, vomiting, or abdominal pain**, which are common early signs of acetaminophen toxicity.  **Vital Signs**: Monitor **vital signs**, especially **blood pressure** and **heart rate**, as changes might indicate systemic complications.  **Lab Values**: Assess **liver function tests** (e.g., ALT, AST) and **serum acetaminophen levels** if available, to determine the severity of the overdose and guide treatment. Renal function: these drugs are excreted through the kidney's Fluoxetine side effects **Central Nervous System**: Headache, nervousness, insomnia, drowsiness, anxiety, tremor, dizziness. **Gastrointestinal**: Nausea, vomiting, diarrhea, dry mouth, anorexia, weight loss. **Skin** **and** **Other**: Sweating, rash. **Sexual**: Sexual dysfunction. **Respiratory**: Upper respiratory infections. **Other**: Fever. These side effects are common reactions to fluoxetine and can vary in severity. Side effects of Salicylate therapy **Side Effects of Salicylate Therapy**: 1. **Gastrointestinal Upset**: **Nausea**, **heartburn**, **stomach pain**, and **indigestion**. 2. **Increased Bleeding Tendency**: **Bruising** more easily or **prolonged bleeding** due to reduced platelet aggregation. 3. **Mild Dizziness** or **lightheadedness**. 4. **Tinnitus (ringing in the ears)** at higher doses. **Adverse Effects of Salicylate Therapy**: 1. **Gastrointestinal Bleeding or Ulcers**: Severe irritation of the stomach lining leading to **bleeding** or the formation of **ulcers**. 2. **Salicylism**: Toxic reaction characterized by **ringing in the ears (tinnitus)**, **dizziness**, **nausea**, **vomiting**, **diarrhea**, **fever**, **mental confusion**, and **lassitude** (fatigue). 3. **Hepatotoxicity**: **Liver damage** in some individuals. 4. **Renal Impairment**: Damage to the kidneys, especially with prolonged use. 5. **Allergic Reactions**: **Rashes**, **hives**, or more severe reactions like **anaphylaxis** in some individuals. 6. **Reye's Syndrome**: A rare but serious condition involving **liver and brain swelling**, primarily when given to children recovering from viral infections like chickenpox or flu. The **side effects** are more common, generally mild, and often manageable, while the **adverse effects** are more serious, may require intervention, and indicate a harmful reaction to salicylate therapy. Patient education for alprazolam For **alprazolam**, here is a more complete version of patient education: 1. **Drug Name and Prescribed Dose**: - **Drug Name**: Alprazolam (commonly known as Xanax). - **Prescribed Dose**: Take exactly as prescribed by your healthcare provider. Do not increase the dose or frequency without consulting your provider. 2. **Measures for Avoidance of Adverse Effects**: - **Avoid Alcohol and Sedatives**: Do not drink alcohol or use other sedatives, as these can increase the risk of severe drowsiness and respiratory depression. - **Driving and Operating Machinery**: Avoid driving or operating heavy machinery until you know how alprazolam affects you, as it can cause **drowsiness** and **dizziness**. - **Risk of Dependence**: Alprazolam can be habit-forming; take it only as directed to avoid dependence or abuse. Do not abruptly stop taking it without medical advice, as it may cause withdrawal symptoms. - **Take with Food if Needed**: To avoid gastrointestinal upset, take alprazolam with food if necessary. 3. **Warning Signs to Report**: - **Difficulty Breathing** or **Severe Drowsiness**: These may indicate an overdose or severe side effect and require immediate medical attention. - **Mood Changes**: Report unusual mood swings, **depression**, or thoughts of harming yourself. - **Confusion or Impaired Coordination**: These symptoms can indicate that the dosage may need adjustment. 4. **Periodic Monitoring and Evaluation**: - **Regular Follow-ups**: Attend all scheduled appointments to monitor effectiveness and any side effects. - **Dependence and Tolerance Monitoring**: Periodic assessment is needed to evaluate for signs of **dependence** or **tolerance**, which are risks with long-term use. This patient education is correct for alprazolam (Xanax), focusing on promoting safe use, avoiding adverse effects, and ensuring adherence through proper monitoring. Nursing actions and patient education prior to giving a benzodiazepine **Nursing Actions Prior to Giving a Benzodiazepine:** 1. **Assess for Contraindications or Cautions**: - **Allergies** to benzodiazepines: Prevent hypersensitivity reactions. - **Liver or Kidney Impairment**: These conditions could alter drug metabolism and excretion, leading to toxicity. - **Conditions Exacerbated by CNS Depression**: Including **glaucoma**, **coma**, **psychoses**, **shock**, and **acute alcohol intoxication**. - **Pregnancy and Lactation**: Benzodiazepines can harm the fetus or be passed through breast milk. - **Use of Other CNS Depressants**: Drugs like **opioids** can lead to increased CNS depression when combined with benzodiazepines. 2. **Baseline Assessment**: - Gather **baseline data** before starting therapy to identify any pre-existing conditions that could be worsened by the drug. - **Assess**: Temperature, weight, skin color and lesions, affect, orientation, reflexes, vision, pulse, blood pressure, perfusion, respiratory rate, adventitious sounds, chronic pulmonary disease, and bowel sounds. 3. **Laboratory Tests**: - Conduct **renal and liver function tests** and a **CBC** to determine if the patient has any existing issues that could affect the drug\'s metabolism, safety, and efficacy. **Patient Education:** It is implied that the patient should be educated about the potential **side effects**, the importance of **not combining the medication** with other CNS depressants (such as alcohol or opioids), and to report any **unusual symptoms** to their healthcare provider. Your response includes all the essential **nursing actions** and **patient assessments** needed before giving a benzodiazepine, which makes it an appropriate answer to the question. 1. Immunizations and passive immunity **Passive Immunity: Detailed Notes** **Definition:** - **Passive immunity** refers to the **temporary protection** provided by **preformed antibodies** that are introduced into the body from an external source. - Since the body does not produce these antibodies on its own, passive immunity is limited and lasts only as long as the circulating antibodies remain active. **Types of Passive Immunity:** 1. **Passive Artificial Immunity:** - **Mechanism:** Occurs when **preformed antibodies** are injected into the body to provide immediate protection against a specific antigen. - **Sources of Antibodies:** - **Animal Plasma:** Antibodies can be manufactured from animals (e.g., horses) that have been infected with a disease, leading to the development of antibodies against that disease. - **Human Plasma:** Antibodies can also be taken from humans who have had a particular disease and developed antibodies against it. - **Examples:** - **Immune globulins** are administered in cases like **snake bites** or **rabies exposure** to provide rapid protection. - **Serum Sickness:** - Sometimes, the recipient's body recognizes the injected antibodies as **foreign proteins**, triggering an immune response. - This can result in **serum sickness**, characterized by: - **Fever** - **Arthritis** - **Flank pain** - **Myalgia** (muscle pain) - **Arthralgia** (joint pain) 2. **Passive Natural Immunity:** - **Mechanism:** This type of immunity occurs **naturally** without medical intervention and involves the transfer of antibodies from one individual to another. - **During Pregnancy:** - **Maternal antibodies** are passed from the pregnant person to the fetus through the **placenta**, providing the newborn with protection against certain infections. - **During Lactation:** - **Human milk** contains antibodies (especially **IgA**) that are passed to the infant, helping to protect against infections, particularly those affecting the **gastrointestinal tract**. - **Action of Circulating Antibodies:** - These antibodies function by **recognizing foreign proteins** (antigens), attaching to them, and rendering them **harmless**, similar to antibodies produced by the body's own **plasma cells**. **Characteristics of Passive Immunity:** - **Temporary Protection:** Unlike active immunity, where the body produces its own antibodies, passive immunity only lasts as long as the injected or transferred antibodies are present in the circulation. - **Immediate Effect:** Passive immunity provides **immediate** but **short-lived** protection, which can be crucial in **emergency situations** like **toxin exposure** or **acute infections**. - **No Immune Memory:** Since the body does not produce these antibodies, passive immunity does not result in **immune memory**. Once the antibodies are depleted, there is no further protection unless more antibodies are administered. **Summary:** - **Passive artificial immunity** involves the injection of preformed antibodies to provide immediate protection, commonly used for **rapid response** against toxins or severe infections. - **Passive natural immunity** occurs through **maternal-fetal transfer** or **breastfeeding**, giving temporary protection to the infant against certain infections. - This form of immunity is **limited in duration** and does not stimulate the body to produce its own antibodies or develop long-term immune memory. - **Immunization** is the process of artificially stimulating **active immunity** by exposing the body to weakened or less-toxic proteins (antigens) related to specific disease-causing organisms. - The goal is to induce an immune response without causing the full course of the disease, providing long-term protection. - **Weakened Bacterial Cell Membranes:** Components of a bacterial cell that have been altered to prevent causing illness while still triggering an immune response. - **Viral Protein Coats:** Parts of a virus that are used to induce immunity without including the virus\'s genetic material. - **Attenuated Virus:** A virus that has been chemically or genetically modified to ensure that it cannot cause disease but can still stimulate the immune system to produce a response. - To **stimulate active immunity**, allowing the immune system to \"remember\" and respond more effectively if exposed to the actual pathogen in the future. - **Adults may require immunizations** for specific situations, such as: - **Exposure** to a particular pathogen. - **Travel** to an area where a disease is **endemic**. - **Occupational Risks:** Working in high-risk areas, such as healthcare or laboratories. - Children in the United States are routinely immunized against many infections that were previously devastating. - Common childhood immunizations include: - **Diphtheria, Pertussis, Tetanus (DPT)** - **Haemophilus influenzae type b (Hib)** - **Hepatitis A and B** - **Varicella (Chickenpox)** - **Poliovirus** - **Measles, Mumps, Rubella (MMR)** - **Meningitis** - **Rotavirus** - **Pneumococcal (PCV)** - **Influenza** - **Meningococcal** - **Human Papillomavirus (HPV)** - **Bacille Calmette-Guérin (BCG) Vaccine for Tuberculosis:** - Used in countries with a high incidence of tuberculosis to limit its spread. - Not routinely used in the U.S. due to the low incidence of tuberculosis and potential to induce **false-positive tuberculin skin test** results. - Smallpox was one of the first diseases for which children were immunized and is now **considered eradicated** globally. - Concerns over **biological terrorism** led to renewed interest in the smallpox vaccine, which was made available to the **U.S. military** to protect against potential terrorist attacks involving smallpox. - Each year in January, the **Centers for Disease Control and Prevention (CDC)** publishes the recommended **immunization schedule**. - These recommendations may change based on experience, exposure, and new developments. - Healthcare professionals are encouraged to stay updated via the CDC website: [CDC Vaccine Schedules](https://www.cdc.gov/vaccines/schedules/index.html). - Though severe reactions to vaccines are **rare**, concerns have arisen about the safety of vaccines, especially when administered to children. - The **central reporting** of adverse or suspected adverse effects helps clarify concerns about reactions to immunizations. - **Allergy Shots (Allergen Immunotherapy):** - Used to help individuals with severe allergic reactions. - Small, controlled doses of the allergen are injected over time, allowing the immune system to become more tolerant. - As tolerance increases, allergy symptoms decrease. - **Sublingual Immunotherapy:** - Many of these antigens are now available in **sublingual form** (under the tongue) to avoid the need for repeated injections. - Immunization artificially stimulates active immunity by exposing the body to weakened antigens, helping to prevent diseases without causing illness. - Routine immunizations protect children from severe diseases, while adults may need vaccinations for specific exposures. - Although rare, adverse effects of vaccines have raised concerns, but continued monitoring and research help maintain the safety of immunization practices. - Immunotherapy for allergies, such as **allergy shots** and **sublingual immunotherapy**, uses a similar principle to help desensitize individuals to specific allergens. First immunization primary signs and symptoms **Adverse Effects of Vaccines: Detailed Notes** **General Adverse Effects:** - **Immune or Inflammatory Reactions:** Adverse effects of vaccines are commonly associated with the immune or inflammatory response stimulated by the vaccine. These effects are typically mild and self-limiting. - **Common Reactions:** - **Systemic Symptoms:** - **Moderate Fever** - **Rash** - **Malaise** (general feeling of discomfort) - **Chills** - **Fretfulness** (irritability) - **Drowsiness** - **Anorexia** (loss of appetite) - **Vomiting** - **Irritability** - **Local Reactions at Injection Site:** - **Pain** - **Redness** - **Swelling** - **Nodule Formation:** Small lumps may develop at the site of injection due to local immune response. **Rare Adverse Effects:** - **Severe Hypersensitivity Reactions:** In rare cases, individuals may experience a **severe allergic reaction** to a vaccine component. Symptoms may include **anaphylaxis**, characterized by difficulty breathing, hives, or swelling. - **Central Nervous System Reactions:** - In very rare instances, vaccines have been associated with **seizures**. These may be due to a **high fever** (febrile seizures) in some children. **Specific Vaccine-Related Adverse Effect:** - **Rotavirus Vaccine:** - The **rotavirus vaccine** has a rare but serious adverse effect known as **intussusception**. - **Intussusception** is a condition where part of the intestine telescopes into itself, causing a blockage. Symptoms may include severe abdominal pain, vomiting, and bloody stools. It requires prompt medical attention. **Summary:** - Most adverse effects associated with vaccines are **mild** and related to the **immune or inflammatory response** being stimulated. - Common effects include **fever**, **rash**, **local pain**, and **swelling**. In rare cases, more severe reactions like **hypersensitivity** or **CNS symptoms** such as seizures may occur. - For the **rotavirus vaccine**, **intussusception** is a rare but potentially serious adverse effect that requires immediate medical intervention. 2. Flu vaccines guiding principles 3. Hep A vaccine adverse effects and nursing actions **Nursing Actions for Hepatitis A Immune Globulin - Assessment and Physical Examination** 1. **Assessment: History** - **Allergies**: Check for any known allergies to Hep A immune globulin or its components to prevent hypersensitivity reactions. - **Pregnancy Status**: Assess if the patient is pregnant, as immune globulins may have contraindications during pregnancy. - **Previous Exposure**: Obtain history of previous exposure to immune globulins, as hypersensitivity reactions can become more severe with repeated doses. - **Coagulation Disorders**: Evaluate for thrombocytopenia or coagulation disorders, as these could be exacerbated by immune globulin administration. - **Immunization History**: Review the patient's immunization history to assess for potential hypersensitivity reactions and to determine if immune globulin is needed. 2. **Physical Examination** - **Inspect for Skin Lesions**: Monitor for any existing skin lesions that could indicate an increased risk of local adverse reactions. - **Vital Signs**: Check temperature, pulse, respirations, and blood pressure to establish baseline data and monitor for possible adverse effects. - **Auscultate Lungs**: Listen for adventitious lung sounds that may indicate respiratory issues or hypersensitivity reactions. - **Assess Mental Status**: Evaluate the patient's orientation and affect to identify potential adverse effects related to immune globulin administration. These actions focus specifically on gathering data before administering the Hepatitis A immune globulin to ensure it is safe for the patient and to establish baseline information for future comparisons. The adverse effects of **Hepatitis A immune globulin** can include: 1. **Local Reactions at Injection Site**: - Tenderness - Muscle stiffness 2. **Systemic Reactions**: - Urticaria (hives) - Angioedema (swelling) - Nausea - Vomiting - Chills - Fever - Chest tightness 4. Pneumonia vaccine patient teaching **Patient Teaching for Pneumonia Vaccine** 1. **Purpose of the Vaccine**: - The pneumonia vaccine helps protect against pneumococcal disease, which can lead to pneumonia, meningitis, and bloodstream infections. It is particularly important for preventing serious complications in high-risk populations, such as older adults, individuals with chronic health conditions, and those with weakened immune systems. 2. **Types of Pneumonia Vaccines**: - **Pneumococcal Conjugate Vaccine (PCV13/PCV15/PCV20)**: Recommended for children, adults over 65, and individuals with certain medical conditions. - **Pneumococcal Polysaccharide Vaccine (PPSV23)**: Typically recommended for older adults (age 65+) and high-risk individuals to provide additional protection. 3. **Vaccination Schedule**: - Explain the recommended schedule based on the patient\'s age and health status. For example, older adults may receive PCV20 or a series of PCV15 followed by PPSV23 for broader coverage. 4. **Eligibility**: - Discuss why the patient qualifies for the pneumonia vaccine based on age (e.g., 65 years or older) or certain health conditions, such as asthma, COPD, diabetes, or heart disease. 5. **Possible Side Effects**: - **Common Side Effects**: Include redness, swelling, or pain at the injection site; mild fever; fatigue; or muscle pain. These usually go away on their own within a few days. - **Severe Reactions**: Rare but serious allergic reactions may occur. Encourage the patient to seek medical attention immediately if they experience difficulty breathing, wheezing, swelling of the face or throat, or hives. 6. **Aftercare Instructions**: - Advise the patient to apply a cold compress to the injection site if they experience pain or swelling. - Recommend over-the-counter pain relievers like acetaminophen or ibuprofen for any discomfort or mild fever, unless contraindicated. 7. **Follow-up**: - Inform the patient about the need for future doses or booster vaccines if applicable, based on age or health condition. Explain that additional vaccinations may be recommended for continued protection. 8. **Importance of Immunization**: - Emphasize the importance of staying up-to-date with vaccinations to reduce the risk of pneumonia and related complications. - Explain how vaccination helps reduce hospitalizations and severe outcomes, especially for older adults and those with underlying conditions. 9. **When to Call the Healthcare Provider**: - Instruct the patient to report any severe side effects or if symptoms such as persistent high fever or worsening pain at the injection site occur. - Encourage patients with weakened immune systems or other high-risk factors to notify their provider if they suspect any health changes after vaccination. 10. **Safety and Myths**: - Address any concerns the patient may have about vaccine safety. Reassure them that the pneumonia vaccine has been extensively tested and is safe for most individuals. - Inform them that the pneumonia vaccine cannot cause pneumonia; instead, it provides protection against pneumococcal bacteria. By providing this information, you help ensure that the patient understands the benefits, possible side effects, and importance of the pneumonia vaccine, promoting adherence to vaccination recommendations. 1. Sports injury & inflammatory response **1. Sports Injury** - Caused by physical trauma (e.g., sprains, strains, fractures). - Leads to tissue damage in muscles, ligaments, or tendons. **2. Inflammatory Response** - The body\'s natural response to injury, aiming to protect and heal tissues. **3. Steps in Inflammatory Response:** 1. **Cell Damage**: Injury damages cells, releasing signals for inflammation. 2. **Histamine Release**: **Mast cells** release histamine, causing vasodilation (widening of blood vessels) and increased permeability of vessel walls. 3. **Vasodilation & Increased Permeability**: More blood flows to the area, and immune cells, along with fluid, move from the bloodstream into the tissue. 4. **Swelling (Edema)**: Fluid accumulation leads to swelling at the injury site. 5. **Immune Cell Migration**: **Neutrophils** and later **macrophages** arrive to clean up damaged tissue and fight any potential infection. 6. **Pain**: Inflammatory chemicals like prostaglandins and cytokines stimulate nerves, causing pain. 7. **Loss of Function**: Swelling and pain limit movement in the injured area. 8. **Healing and Repair**: Immune cells clear debris, and tissue repair begins with fibroblasts creating new tissue. **4. Signs of Inflammation** - **Redness** - **Heat** - **Swelling** - **Pain** - **Loss of function** **5. Management** - **RICE**: Rest, Ice, Compression, Elevation to control swelling and pain. - **NSAIDs**: Medications to reduce inflammation and pain. - **Physical therapy**: Helps restore function after healing. 2. Autoimmune disease & pathophysiological process and client symptoms 3. Phagocytosis and tumor cells 4. Rheumatoid arthritis -- NSAIDs and contraindications with antihypertensives 5. Clients with hepatitis education about acetaminophen 6. Seizures caused by a neurotransmitter deficiency 7. ETOH withdrawal & seizures which medication will meet this client's needs? 8. Factors that could exacerbate the effects of benzo's 9. Fluvoxamine client teaching 10. Lamotrigine adverse effects 11. Zolpidem sleep aid guidelines for patient treatment 12. Serotonin deficiency priority assessment 13. Benefits of Buspirone to treat anxiety over other anxiolytics 14. Lorazepam PO side effects for African Americans 15. Antimanic drugs for long term maintenance of bipolar disorder 16. Antipsychotic medications and cautions that may cause CNS depression